Ok get your mind out of the gutter. I’m talking about
STEP LENGTH.
I have a fundamental problem with one-size-fits-all solutions. I’m just about done with articles and YouTube videos with titles like “The 5 exercises EVERYONE should be doing everyday”. They just don’t hold up. Whenever I watch a video with a title like this, I can invariably think of at least 3 orthopedic issues that result from each of the recommended exercises when they’re applied to the wrong body.
Yes, we’re all humans, and yes we all have the same basic anatomy, but there are so many variations within that common anatomy that blanket solutions that are espoused to apply to EVERYONE can be downright dangerous.
Personally, I love that patients have knowledge at their fingertips these days. I don’t believe doctors should own all the information on our bodies as they have historically, and hand down non-negotiable decisions from on-high during a 5-minute consult. Frankly, the world of healthcare is starting to look more and more like the Wild Wild West. We HAVE to be our own advocates, we HAVE to be educated consumers. So I for one love when my patients have done their own research and come to me with a list of questions based on their reading. If you ever sit down with a health professional that gets irritated by you doing your own research, run the other way – that person’s ego has gotten the better of them. Or they have about 30 seconds for you, which doesn’t allow a lot of time for collaboration.
My work with patients is a 2-way conversation. I bring my expertise in anatomy and movement, and they bring their expertise in their experience of pain or dysfunction and their goals for the future. We have to be able to come together and agree on a plan that promotes health within the bounds of that very specific person’s life and their very specific abilities, limitations and preferences. I once had a patient tell me I could only give her exercises she could do at her desk (because she worked 3 bazillion hours a week). I could have tried to make her change her lifestyle, but I was much more effective working within it.
But back to gait…
When I’m in an airport, I LOVE to analyze gait (walking pattern). The hallways are long, so it gives me ample opportunity to zoom out and then zoom in on a given individual and guess what hurts or what’s weak or what injuries they’ve had in the past. A person’s orthopedic history is absolutely EMBEDDED in their gait pattern. Unfortunately, in the airport, I never get to know if I was right or wrong, because I do have enough social awareness not to approach strangers and ask them what’s hurting. But in the clinic, I get the fun privilege of connecting all the dots about how a patient’s gait pattern tells the story of their pain. And, despite my previous statement that generalizations almost never hold, there is one thing I find myself saying over and over:
“Your steps are too big”.
It’s kind of like when I say “Yoga keeps me in business”. People stop – and say “What?! I thought that yoga was the key to orthopedic and spiritual enlightenment!” And “I thought big steps were a sign of STABILITY, YOUTH AND VIGOR!”
Nope.
Your big steps are not a sign of your stability, youth and vigor. They are a manifestation of your overcompensation for…
Your Aunt Hilda’s steps,
that became smaller as she aged and you want to make DARN sure that you don’t end up looking like Aunt Hilda (who was probably awesome and sassy and took totally appropriate steps for her 4’11” frame).
-OR-
Your Grandpa Steve,
who died of a heart attack in his 60’s and you KNOW that cardiovascular exercise is important in the prevention of heart disease, so the one and only metric you care about when you take a walk is your heart rate.
(nevermind Grandpa Steve was a chain smoker that lived on Doritos while he sat at a desk for 40 years)..
But you, YOU, are never going to succumb to the weaknesses of these ancestors. You’re going to do BETTER (even if better means swinging the pendulum WAY the other direction).
Here are 2 unfortunately common orthopedic implications of pushing your step length and your gait speed to overcompensate for the short-comings of your predecessors:
- Hip replacement
- Lumbar fusion
Yes – I deliberately went big on both of those implications to get your attention. Sure, there’s a spectrum, and usually there are years of pain and suffering before we arrive at either of the above. But I’m getting right to catastrophic to make a point. Here are the details:
- Hip replacement:
When you take big steps, you stress the hip joint as the leg goes behind the body. Our ball and socket joints (the hip and shoulder) are incredible in their capacity for MOBILITY, but with mobility comes the risk of INSTABILITY.
Instability, in the context of the hip, is when instead of just rotating and staying beautifully centered in its socket, the ball starts to slide around in directions it’s not meant to go.
When the hip goes into too much extension (the leg goes too far behind the body), as happens when you’re taking a supersize step, the ball (femoral head) starts to slide forward progressively in the socket (acetabulum).
If this happens often enough (like every step you take), you start to develop degenerative change at the front side of the socket from the ball knocking against it over and over, and you also irritate the soft tissue at the front side of the joint from constantly OVER – yes OVER-stretching it. And eventually, that manifests as discomfort at the front of the hip.
Now here’s where things really go south: when something aches, what do we assume? That’s right:
We assume it’s TIGHT and needs to be STRETCHED.
Here’s where the information at our fingertips might become problematic. We use the google machine to look up “How to stretch the front of the hip”, and we come up with something like this:
And instead of reducing the ache, we make it GROW. Because doesn’t this just look like a more aggressive version of taking a big step?
You keep up those big steps and hip flexor stretching long enough, eventually you get the privilege of 30 seconds with an orthopedic surgeon, who takes one look at your imaging (probably doesn’t watch you walk) and offers you the opportunity to contribute to his boat fund.
Just kidding.
He already has a boat.
2. Lumbar fusion
When you take big steps, you create what my guru in the PT world, Shirley Sahrmann, calls a “Wobble wobble” at the lumbar spine (low back). Here’s this woman’s second opportunity to be my covergirl for lumbar instability (see her debut in “Are you doing your 80%?“):
Underneath all that style, her L5 vertebra (the one at the very bottom) is getting rotated.
Over and over and over.
Vertebrae HATE that. Remember from my previous ramblings in To Stretch or Not to Stretch how our center is meant to be the STILL foundation upon which our extremities move? Well, the big steps destroy that foundation.
Add 40 years to this woman’s walking pattern, and suddenly the images show vertebrae slipping this way and that. And she’s gained 50 pounds because her back hurts so bad that she stopped walking about 15 years ago. And her knee hurts too because downstream joints suffer when they don’t have a stable platform to launch from.
And low and behold, this specimen of beauty, vitality and youth has the privilege of 30 seconds with an orthopedic surgeon who looks at her very messy radiology findings and declares “Yep – I can FIX that”.
And she sends his kid to Harvard.
Just kidding.
Yale.
All of this from taking steps that are too big?? Yes, people. I’m not even exaggerating. A large portion of my patient population is adults ages 60+. I see these downstream effects of big steps EVERY WEEK. Unfortunately, in many cases I’m seeing a patient after it’s been going on for so long that a lot of the physical damage has already been done. I’ll be the first one to tell you that even with a hot mess of an MRI we can often get to a good place without surgery, but wouldn’t it be great to catch it before it comes to that?!
Let’s do better, people!
Let’s supersize our FRENCH FRIES!
NOT our steps.
Just kidding.
Please don’t do that either.
The Movement Mama 
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